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It may be inaccurate to say the premiums have increased and leave it at that. The industry must now provide standard comprehensive coverage which give full coverage as opposed to the mini coverage for which people paid. It is a better deal from the point of consumer advocacy. But that aside what I find absolutely astonishing is the way the industry creates loopholes wherein compliance is made but “around the corner” legal escapes are implemented wherein they outsmart and circumnavigate legislative intent all the time. For example since they have to cover high risk people , to reduce costs they are dropping the doctors from the plan that treat high risk patients. It’s just like the terrorists. Every time security adds a protocol the terrorists invent a way to evade it.

Hello Carl. Good to hear from you. You always make good points and give thoughtful feedback.

Let’s go point by point.

Before the ACA:
I think we have to be careful describing the previously sold policies as “mini”. Varying deductibles not withstanding, most had generous first-dollar benefits (co-pay for doctor visits) and small co-insurance for most testing. Also, studies show that 85% of people in this country had medical insurance prior to ObamaCare and nearly 9/10 were satisfied with their coverage. As you alluded to, there was no carve out for preventative things per se, but these services tend to be relatively inexpensive anyway.

I suppose if you need a pap smear, mammogram, birth control pills, pediatric well-care, a routine physical with blood work, smoking cessation counseling and mental health counseling…. all in the same year… it will be a bargain for sure!

I think it is an error in analysis to generalize that the benefit of “comprehensive coverage” will apply to most people most of the time. And, as the saying goes, “the devil is in the details”. Let’s list some of the issues:

1) One size fits all benefit package: We all (those that buy on the exchange plus tax payer subsidies) pay for all of the “comprehensive coverage” whether we need it or not. Very few people will take yearly advantage of all the long list of “essential services” that are mandated under the ACA for exchange-sold policies to individuals, but yet we pay for all these benefits. For example, why should a 45 y/o female who has had a hysterectomy whose children are grown, have to carry the expense of maternity benefits and pediatric well-care? In my case, a 56 year old male in good health and non-smoker – non-drinker, why should I have to carry the expense of drug and alcohol coverage?

2) Higher out-of-pocket limits: Most policies sold on the exchanges have higher out-of-pocket maximums compared to their comparable predecessors in the private market (around $12,500). This is very important because the size and scope of most exchange policy’s networks will likely be smaller as a way to hold down costs. This means that folks will be more likely to incur out-of-network care, meaning more out-of-pocket expenses as a percentage of the total cost. And, unless it is one of the 10 essential services covered without cost sharing, there will always be some out-of-pocket expenses and possibly no coverage if out of network.

3) Simple economics: Finally, and most importantly, is the financial structure of the ACA sustainable? It depends entirely on healthy enrollees to balance the insurance pools. Here is the reality: insurance will look like a bargain to the sicker folks (especially if subsidized) and it will look too expensive to the healthy, especially the young and healthy (the invincible) . If the healthy opt out and self insure, thus paying a penalty, then the network payout costs will be way out of skew compared to revenue. Premiums will necessarily go up, thus eventually making it even less attractive to the healthy and the cycle goes on. It leads to what some economic analysts calls a death spiral.